Facial palsy (FP) can be differentiated into central-or peripheral-type FP, and further, into volitional or emotional FP. A 56-year-old man visited our emergency department because of acute vertigo. The physical examination showed weakness of left facial mimetic muscles when smiling happily or frowning nervously, but no weakness was observed when purposely winking, pouting or grimacing. Thus, left emotional central-type FP was confirmed. Also, hemihypesthesia occurred at his right-side trunk and right limbs, and an acute left lateral medullary infarction was confirmed by magnetic resonance imaging. Emotional central-type FP with lateral medullary infarction has been reported in foreign literature but this has not been described in Taiwan literature yet. According to neurological localization, emotional central-type FP is attributable to lateral brainstem lesion, and should be differentiated from common central-type FP (both volitional and emotional) caused by cerebral infarction.